Triple Whammy: Concurrent High-Altitude Exposure and COVID-19 Infection Presenting With STEMI

Background:High altitude is associated with altered cardiovascular, pulmonary, and blood physiology which can lead to various cardiovascular complications The world is now facing grave pandemic of COVID-19, which has affected all regions of the world including high-altitude regions Management of COVID-19 infection along with a medical emergency like acute coronary syndrome at high altitude is extremely challenging Case Presentation:We present a 57-year-old paramilitary officer, acclimatized to high altitude who developed sore throat, fever, and cough while he was posted at an altitude of 3,500 m Evaluation revealed positive reverse transcriptase polymerase chain reaction (RT-PCR) test for COVID-19;hence, he was managed in isolation ward with symptomatic therapy During the hospital stay, he developed anterior wall ST-elevation myocardial infarction (STEMI) for which he underwent thrombolysis with Tenecteplase He underwent air evacuation to a tertiary care center located at an altitude of 320 m Three days later, his repeat RT-PCR was negative However, he complained of angina at rest;hence, he underwent coronary angiography which revealed significant mid-left anterior descending artery disease for which percutaneous coronary intervention was done successfully Patient was discharged on optimal medical management, and on follow-up at 1 month he remained asymptomatic Conclusion:This case highlights the deleterious effects of high altitude on cardiovascular system which can get worsened by COVID-19 infection In patients suffering triple whammy of high-altitude exposure, COVID-19 infection and STEMI, multipronged approach involving timely medical management, rapid evacuation, and necessary intervention can provide optimal clinical outcomes